In situ immunodetection of antigens

ABSTRACT

An antibody targeted to an antigen is brought into contact with a body component in situ. The resulting antibody/antigen complex is labeled and may be amplified. The label is then detected either in situ or ex situ.

BACKGROUND

The present invention relates to in situ immunodetection of antigens.

Numerous devices and methods are known for detecting antigens ex situ,i.e., on or within tissue, fluid or other samples that have been removedfrom the body. In a typical protocol antibodies may be raised againstone or more epitopes on a target protein by injecting the protein into arabbit, human or other host, allowing the host to produce antibodiesagainst the protein, and then removing and purifying sera from the host.The antibody is then brought into contact with the sample undercircumstances which are favorable for the formation of anantibody/antigen complex. In cases where the signal is low, such aswhere the amount of antigen is low or the antigen/antibody binding ispoor, one or more amplification steps may be used. Typically, a visiblechromophore, radioactive, fluorescent, oligonucleotide or other markeris attached to the antibody or to one of the amplification reagents tofacilitate detection of the antigen complex. The terms "label" and"marker" are used herein interchangeably.

Antibodies used in such methods may be more or less specificallyselective for the target antigen, and may bind with a greater or lesserefficiency to the target antigen. Typically, useful antibodies will havea good specificity for the target antigen and an association constant(ka) of approximately 10³ -10⁹ with the target antigen. Antibodies mayalso be polyclonal or monoclonal, or some combination of the two.

A known method of immunodetection designed by Charles Cantor uses twodifferent antibodies. A first step biotinylated, monoclonal orpolyclonal antibody is used to detect the target antigen(s), and asecond step antibody is then used to detect the biotin attached to thecomplexed biotin. In that method the sample to be tested is firstincubated in a solution containing the first step antibody. If thetarget antigen is present, some of the antibody binds to the antigen toform a biotinylated antibody/antigen complex. The antibody/antigencomplex is then amplified by incubation in successive solutions ofstreptavidin (or avidin), biotinylated DNA, and/or complementarybiotinylated DNA, with each step adding additional biotin sites to theantibody/antigen complex. The amplification steps are repeated until asuitable level of amplification is achieved, at which point the sampleis incubated in a solution containing the second step antibody againstbiotin. This second step antibody is labeled, as for example with anenzyme that can be used to detect the presence of the antibody/antigencomplex by histoenzymology using a chromogen substrate. With suitableamplification, a conjugate can be produced which is macroscopicallyvisible.

Another known method of immunodetection takes advantage of theimmuno-PCR (Polymerase Chain Reaction) methodology (2). The PCR methodis similar to the Cantor method up to the incubation with biotinylatedDNA, however, instead of using multiple rounds of streptavidin andbiotinylated DNA incubation, the DNA/biotin/streptavidin/antibodycomplex is washed out with a low pH or high salt buffer that releasesthe antibody. The resulting wash solution is then used to carry out aPCR reaction with suitable primers with appropriate controls. At leastin theory, the enormous amplification capability and specificity of PCRcan be utilized to detect a single antigen molecule.

Still other methods may utilize synthetic antibodies such as thoseavailable through molecular imprinting technology (see, e.g., U.S. Pat.No. 5,110,833 to Mosbach). As used herein, the terms "antibody" and"antibodies" include synthetic antibodies and other antibody analogs.

While these and other known methods of immunodetection have been appliedto nonliving materials, and to living cells ex situ (e.g., tumor cells(3), they have never to our knowledge been applied in situ. As usedherein in situ refers to tissues, cells, fluids and other bodycomponents that are still coupled to the body during the antibodybinding step, as opposed to having been biopsied or otherwise removedfrom the body for the antigen binding step.

Application of antigen detecting methods to in situ body components ishighly desirable. For example, such methods can be performed outside theconfines of a laboratory or clinical setting, without the taking oftissue samples. Where the results are visualized macroscopically, themethods can also be performed without the need for specialized equipmentsuch as microscopes or plate readers (4). In situ detection of antigenson a body surface such as the skin of a patient, for example, canfacilitate field screening of numerous pathogenic agents such as virus,bacteria, fungi and mycoplasma appearing on the skin surface, and assistin the diagnosis of skin conditions such as psoriasis. In situ detectionof antigens may also be used to detect antigens which are present belowthe surface of the skin, such as where the detection takes place in anopen wound or an incision, or in a body cavity. In these and otherinstances, antigens are said to be proximally associated with a bodycomponent if they can be detected with application of one or more of thedevices and methods disclosed herein to the body component.

Due to the presence of Langerhans and other specialized cells in theskin, in situ immunodetection of antigens may also be useful in thediagnosis and prognostication of systemic diseases including AIDS andsome cancers. Langerhans are professional antigen presenting cells(APCs) which comprise approximately 2% of the human skin cellpopulation. They function both as the skin's antigen presenting cellsand as depositories for foreign antigenic fragments, accumulating andpresenting at the skin surface circulating antigens characteristic of abroad range of localized and systemic conditions. In the case of AIDS,for example, it is known that human immuno-deficiency virus can infectLangerhans cells, (5), and that resident Langerhans cells can containthe HIV-1 gag protein and have viral particles budding from theirmembranes(6,7). Proviral DNA(5) and tat, rev, nef and env mRNA(8) havebeen demonstrated in Langerhans cells, and HIV-specific nucleic acidshave been detected on the surface of biopsied skin specimens using PCR(8).

Of course, in situ immunodetection of disease conditions need notnecessarily rely on Langerhans cells. Keratinocytes, for example, areepidermal cells which are primary targets of Human Papilloma Virus(HPV), and a topical test for HPV antigens could be developed inaccordance with the devices and methods disclosed herein.

Thus, there is a need to provide devices and methods for in situimmunodetection of antigens.

SUMMARY OF THE INVENTION

The present invention involves immunodetection of antigens in which anantibody is brought into contact with a body component in situ, and theresulting antibody/antigen complex is then detected either in situ or exsitu.

In one aspect of the invention, a retainer is applied to a body partsuch as the skin or mucous membrane of a patient, and one or more firststep antibodies are brought into contact with the body part within theconfines of the retainer. Some of the first step antibody binds toantigens present at or near the body part, and unbound first stepantibody is washed away. Antibody/antigen complex may then be amplifiedto an appropriate level, and a second step antibody is brought intocontact with the antibody/antigen complex to render the complexmacroscopically detectable.

In another aspect of the invention, the bound antibody is removed fromthe body part and processed ex situ. For example, the boundantibody/antigen complex can be washed out, and the resulting washsolution can be used to carry out a PCR reaction.

Other aspects of the invention involve modifications to the retainer(s).For example, a first retainer may comprise a bandage which holds anantibody impregnated paste in contact with a skin surface. After anappropriate incubation period, the bandage is removed and the boundantibody/antigen complex is processed in situ, ex situ, or using somecombination of the two.

Still other aspects of the invention include panels or series of testsfor screening purposes.

BRIEF DESCRIPTION OF THE DRAWING

These and other aspects of the present invention will become betterunderstood through a consideration of the following description taken inconjunction with the drawing in which like numerals represent likecomponents:

FIG. 1 is a diagrammatic representation of the application of aring-shaped retainer to the skin of a patient.

FIG. 2 is a diagrammatic representation of a process for detectingantigen on a body part using first and second step antibodies.

FIG. 3 is a diagrammatic representation of a process for detectingantigen on a body part using Immuno-PCR.

FIG. 4 depicts significant sequential steps from an alternative protocolfor identifying antigen.

BRIEF DESCRIPTION OF THE DRAWING

In FIG. 1, a retainer 1 is applied to the skin on the back of apatient's hand 2. In this instance the retainer 1 is a ringapproximately 1 cm in diameter and 0.5 cm. high, and the retainer 1 ismanufactured from polypropylene plastic. Of course, other sizes andshapes and other materials which minimize interference with theprocedures may also be used. An adhesive layer 3 preferably coats thebase of retainer 1, and serves to adhere and conform the retainer 1 tothe hand 2. In a preferred embodiment, the adhesive comprises removabledouble-sided mounting squares such as 3M Scotch™ squares available fromBoise Cascade office products, tel: 800-562-1746.

Numerous alternatives to the retainer 1 shown in FIG. 1 are possible.Alternative retainers may, for example, have some other cross-sectionalshape such as oval or polygonal. They may also have dividers separatingthe testing area into multiple compartments or wells. Also, retainersneed not have adhesive on the bottom surface, but may be affixed, i.e.,kept in juxtaposed relation with the skin or other body component, byother means such as an elastic band or a bandage. Alternative retainersmay also be constructed of a flexible material such as an adhesivebandage, having, for example, a patch of cloth impregnated withantibodies. Where the body component being tested is below the normalsurface of the skin, such as may be present with a wound, blister orchancre, or when the body component being tested is a mucous membrane,the retainer may be affixed to the skin adjacent to the testing area.

It is also possible to provide a retainer having a cavity adapted toreceive a body component, rather than adapted to be affixed to a bodycomponent. For example, a retainer may comprise a test tube or beakercontaining one of the reagents, and a body component such as a fingercan be brought into contact with the reagent by inserting the bodycomponent into the retainer.

Still other embodiments are possible, provided that some means is usedto maintain contact between certain reagents and the body componentbeing tested for suitable periods of time.

These periods of time may have larger or smaller acceptable ranges,depending on many factors including surface and ambient temperature, andthe reagent being utilized. Thus, it may be possible to perform thenecessary steps without any retainer at all, as for example where thebody component being tested comprises a wound or invagination, orpresents a cupped surface such as a hand. It may also be possible toperform the necessary steps without any retainer for steps in which thereagent is sufficiently viscous to maintain its contact with the bodycomponent.

In FIG. 2, a first step antibody 4 is brought into contact with the skinor other body component 2 in situ, where it has an opportunity tocontact the targeted antigen(s) 5. The first step antibody 4 must beable to bind with at least one antigenic determinant on the targetedantigen, and is preferably of the monoclonal or polyclonal type due tothe availability of raising antibodies in those forms to essentially anyidentifiable antigen. First step antibodies can be produced according toone of the classical method of antibody production. (11) Such antibodiesmay be more or less selective to the target antigen, and may bind moreor less strongly to the target antigen. In some instances the use ofpolyclonal antibodies will be advantageous because they have the abilityto recognize multiple epitopes, however, the use of polyclonalantibodies generally also results in reduced specificity. Wheremonoclonal first step antibodies are used, it is preferable to raise theantibodies against an epitope in it natural conformation (9) to aid inbinding. Some combination of monoclonal or polyclonal antibodies mayalso be used, such as in a screening panel.

In a preferred embodiment the first step antibody 4 is conjugated tobiotin (biotinylated). Other labels may be used, including peroxidaseand alkaline phosphatase, and it is also possible to utilize the firststep antibody 4 without being conjugated to any label at all. The firststep antibody 4 may be present in many forms, including a liquidsolution or a viscous paste. The first step antibody 4 may also bedeposited on a surface, such as an adhesive bandage, which is broughtinto contact with the body component 2 being investigated.

Also shown in FIG. 2 is a second step antibody 6 selectively binding tothe first antibody 4. The second step antibody 6 is advantageously ofthe polyclonal antibody type because of its ready availability, lowercost and its ability to give a stronger signal, and is preferablyincluded in a liquid solution for ease of use. The second step antibody6 may be conjugated to biotin markers 7, or it may alternatively bebound to colloidal gold, an enzymatic fragment, or any other appropriatecolored or chromogen substance including chromophore, dye, or liposomeloaded with dye.

Implicit in FIG. 2 is the use of necessary reagents to carry out thetesting. Where the testing is performed on living tissue, it isobviously desirable to use nontoxic and nonirritating reagents, butthese are not absolute requirements, and any negative effects must beweighed against the value of the testing.

An amplification step may or may not be employed, depending on thestrength of the signal and the signal to noise ratio. This in turndepends on many factors known to those in the art, including as theamount of antigen and the strength of the antigen/antibody binding.Where an amplification step is utilized, the amplification steppreferably comprises the biotin, streptavidin, a biotinylated DNAtechnology described by Cantor (1), which article is incorporated hereinin its entirety.

Other amplification technologies are also applicable, including twosteps, 3 steps, PAP, and APAAP methods.

In one possible amplification step, (not shown), a fragment of nucleicacid or an analog such as a molecular polymer can be used to bind to thestreptavidin/biotin/antibodies complex. If such a fragment is used, itshould be rare enough to diminish the possibility of amplifying anunrelated DNA fragment. A gene fragment from a thermophile bacterium,for example, is a good candidate (10). Such a fragment can also belabeled with a biotin or other marker such as a fluorescent dye,although labeling with a staining substance is preferred so that thestreptavidin/biotin/antibodies complex can be conveniently detected withthe unaided eye.

In FIG. 3, antibody 10 binds selectively to target antigen(s) 5, and theresulting antibody/antigen complex is washed out with a low pH bufferthat releases the antibody. Numerous means can be used to achieveadequate antibody elution. For example, in cases where the backgroundsignal is too high, a high pH buffer of Sodium Citrate pH 6.0 0.1M canbe used to wash the sample before elution. Forantibody/streptavidin/biotin/DNA complex elution, one can use (1) a highsalt concentration (1-2M) of NaCl in PBS buffer pH 7.1, (2) a low pH(3.5) sodium citrate buffer 0.1M, (3) WALPOLE (acetic Acid SodiumAcetate) buffer at pH 3.5, or (4) a solution of 0.5-2% sodium dodecylsulfate. The resulting wash solution is used to carry out a PCRreaction, which serves to amplify the bound DNA. While otheramplification steps can be used, FIG. 3 depicts the use of biotinylated12 first step antibody 10, biotinylated 12 streptavidin 14, and PCRoperating on biotinylated DNA 16 according the disclosure of (2), whichis incorporated herein in its entirety. The PCR amplification methodshown is especially advantageous where the amount of antigen to bedetected is very small, e.g., 500 molecules.

FIG. 4 depicts steps from an alternative protocol for identifyingantigen. In step A, a biotinylated 24, monoclonal antibody 22 is allowedto bind to cell surface antigen 20. In step B, streptavidin 26 having amarker such as colloidal gold 27 is then bound to the biotin molecule 24of the antibody 22. In step C, biotinylated single strand DNA (ssDNA) 28is bound to the streptavidin 26, and in step D, complementarybiotinylated 24 DNA 30 hybridizes to the already complexed DNA 28.

USE OF THE INVENTION

The devices and methods disclosed herein can be used to identify a broadrange of pathogenic agents including virus, bacteria, fungi, mycoplasma,along with the detection and diagnosis of systemic diseases includingbut not restricted to AIDS, HIV, hepatitis A, B, C and tuberculosis. Thedevices and methods disclosed herein may also be used as a screeningtool, and for prognostication and follow up of a treatment regimen. Forexample, the human papilloma virus (HPV) family consists of closelyrelated strains, and in order to develop an effective therapeuticstrategy against a specific strain, an accurate identification tool isrequired. A topical skin test such as the one described aboveconstitutes such a tool. Another exemplary usage involves thedifferential diagnosis between melanoma and fungal skin infection. Thecurrent procedure usually requires a biopsy and subsequent examinationof the sample by a pathologist. Such a procedure is not only expensiveand time consuming, but it is also invasive. By comparison, a surfaceskin test under the procedure of example 2 below can be used to make thedifferential diagnosis, but has tremendous advantages in time, costreduction and non-invasiveness.

The devices and methods disclosed herein may also have significantadvantages in terms of the flexibility of the mode of delivery. Forexample, some tests in accordance with the disclosure herein can be usedwithout a laboratory, and can be both non-invasive and nontoxic. Suchtests can be utilized advantageously not only by clinicians, hospitals,reference laboratories, and public health facilities, but also by fieldworkers in under- and undeveloped areas throughout the world.

EXAMPLE 1

A test involving a Cantor-type amplification can be performed asfollows:

SOLUTION A: General buffer

    ______________________________________    D-PBS pH 7.1               (Dulbecco formula) with Calcium & Magnesium               (ICN Cat No: 18-610-54)    CaC12 anhyd.               0.10 g/L    Kcl        0.20 g/L    KH2PO4     0.20 g/L    MgCl2 6H2O 0.10 g/L    NaCl       0.80 g/L    NaH2PO4 7H2O               2.16 g/L    ______________________________________

SOLUTION B: Blocking buffer.

2 mg/ml bovine serum albumin (crystalline) (ICN Cat No:103700) in D-PBSpH 7.1 (Dulbecco formula) with Calcium & Magnesium (ICN CatNo:18-610-54).

SOLUTION Ca: First step antibody 1

z1 ml of 1/1000 dilution in solution B of concentrated serum candidaalbicans goat polyclonal (Immuno-mycologics Inc., tel: 800-654-3639.)

SOLUTION Cb: First step antibody 2

1 ml of 10 ug/ml of mab NKI-C3 anti Melanoma associated Ag 25/110 kdIgG1MAB (Caltag Laboratory, Inc., tel: 800-874-4007) in solution B.

SOLUTION Da: Second step antibody 1

50 ug/ml of biotinylated Donkey anti Goat IgG(H+L) in solution B.(Jackson Immunoresearch cat no.: 705-065-003, tel: 800-367-5296).

SOLUTION Db: Second step antibody 2

50 ug/ml of biotinylated Goat antimouse IgG(H+L) in solution B. (JacksonImmunoresearch, cat: 115-035-003, tel:800-367-5296).

SOLUTION E: Streptavidin/20 nm gold solution.

10 ug/ml streptavidin 20 nm gold (ICN cat No 67-870-2,tel:800-854-0530).

SOLUTION F: Biotinylated DNA solution.

100 ug/ml in solution B. The DNA has the following sequence, which isthe first 300 nucleotides of the DNA repair gene recA of Thermusaquaticus bacteria (10).

5' GAGCCAGGCC CTGAGGAAGC TGACCGCCGT CCTCTCCAAG AGCAACACCG CCGCCATCTTCATCAACCAG GTGCGGGAGA AGGTGGGGGT CATGTACGGC AACCCCGAGA CCACGCCGGGCGGCCGGGCC CTCAAGTTCT ACTCCAGCGT GCGCCTGGAC GTGCGCAAAA GCGGCCAGCCCATCAAGGTG GGCAACGAGG CCGTGGGCAT CAAGGTCAAG GTCAAGGTGG TGAAGAACAAGCTGGCCCCG CCCTTCCGGG AGGCGGAGCT 3'

The DNA is labeled with biotin-14-dCTP using the random priming method(i.e., Bioprime non radioactive DNA labeling system Cat No: 18094-011Gibco BRL, Tel: 800-828-6686) or other alternative methods (i.e., PCR).

In the Clinical Facility:

1) Prepare the skin by rubbing it with 70% ethanol, peel off theadhesive ring protection and attach the ring to the skin.

2) Rinse inside the ring with 1 ml solution A.

3) Add 0.5 ml of solution C (first step antibody) waits 3 min.

4) Rinse 3 times with solution A.

5) Add 0.5 ml of solution D (second step antibody) and wait 3 min.

6) Rinse 3 times with solution A.

7) Add 0.5 ml of solution E (streptavidin/gold solution) and wait 3 min.

8) Rinse 3 times with solution A.

9) Add 0.5 ml of solution F (biotin/DNA) and wait 5 min.

10) Rinse 3 times with solution A.

11) Add 0.5 ml of solution E (streptavidin/gold solution) and wait 3min.

The appearance of a red immunostain indicates a positive result.

EXAMPLE 2

A test involving PCR amplification can be accomplished in the followingmanner. The following reagents are prepared and/or acquired:

SOLUTION A: General buffer

    ______________________________________    D-PBS pH 7.1               (Dulbecco formula) with Calcium & Magnesium,               ICN Cat No: 18-610-54    CaC12 anhyd.               0.10 g/L    Kcl        0.20 g/L    KH2PO4     0.20 g/L    MgCl2 6H2O 0.10 g/L    NaCl       0.80 g/L    NaH2PO4 7H2O               2.16 g/L    ______________________________________

SOLUTION B: Blocking buffer

2 mg/ml bovine serum albumin (crystalline) (ICN Cat No:103700) in D-PBSpH 7.1 (Dulbecco formula) with Calcium & Magnesium (ICN CatNo:18-610-54).

SOLUTION Ca: First step antibody 1

1 ml of 1/1000 dilution in solution B of concentrated serum Candidaalbicans goat polyclonal Ab (Immuno-Mycologics Inc., tel: 800-654-3639).

SOLUTION Cb: First step antibody 2

1 ml of 10 ug/ml of mab NKI-C3 anti- Melanoma associated Ag 25/110 kdIgG1MAB (Caltag Laboratory Inc., tel: 800-874-4007) in solution B.

SOLUTION Da Second step antibody 1

50 ug/ml of biotinylated Donkey anti- Goat IgG(H+L) from (JacksonImmunoresearch, Cat: 705-065-003, tel: 800-367-5296) in solution B.

SOLUTION Db: Second step antibody 2

50 ug/ml of biotinylated goat antimouse IgG(H+L) from (JacksonImmunoresearch, Cat: 115-065-003, tel: 800-367-5296) in solution B.

SOLUTION E: Streptavidin solution 10 ug/ml streptavidin from (JacksonImmunoresearch, Cat: 016-000-084, tel: 800-367-5296).

SOLUTION F: Biotinylated DNA solution

100 ug/ml in solution B. The DNA has the following sequence, which isthe first 300 nucleotides of the DNA repair gene recA of Thermusaquaticus bacteria (10).

5' GAGCCAGGCC CTGAGGAAGC TGACCGCCGT CCTCTCCAAG AGCAACACCG CCGCCATCTTCATCAACCAG GTGCGGGAGA AGGTGGGGGT CATGTACGGC AACCCCGAGA CCACGCCGGGCGGCCGGGCC CTCAAGTTCT ACTCCAGCGT GCGCCTGGAC GTGCGCAAAA GCGGCCAGCCCATCAAGGTG GGCAACGAGG CCGTGGGCAT CAAGGTCAAG GTCAAGGTGG TGAAGAACAAGCTGGCCCCG CCCTTCCGGG AGGCGGAGCT 3'

The DNA is labeled with the biotin-14-dCTP using the random primingmethod (i.e.: Bioprime non radioactive DNA labeling system (Gibco BRL,Cat No: 18094-011, tel: 800-828-6686), or other alternative methods thatcan be used to incorporate biotinylated nucleotides in a 300 bp DNAsequence.

SOLUTION G: Eluting Solution (1M NaCl/PBS)

NaCl: 58.44 g/L in solution A.

The Clinical Or Testing Facility:

(1) Prepare the skin of the patient in situ by rubbing it with 70%ethanol.

(2) Peel off the adhesive protection of the work space ring or otherretainer as described above, and affix the retainer to the skin todefine the area of skin to be tested (the testing area).

(3) Rinse the testing area and the entire work space with 1 ml ofsolution A.

(4) Add 0.5 ml of solution C (first step antibody) to the testing area,and wait 3 min.

(5) Rinse the testing area and the entire work space 3 times withsolution A.

(6) Add 0.5 ml of solution D (second step antibody) to the testing areaand wait 3 min.

(7) Rinse the testing area and the entire work space 3 times withsolution A.

(8) Add 0.5 ml of solution E (streptavidin solution) to the testing areaand wait 3 min.

(9) Rinse the testing area and the entire work 3 times with solution A.

(10) Add 0.5 ml of solution F (biotin/DNA) to the testing area and wait5 min.

(11) Rinse the testing area and the entire work 3 times with solution A.

(12) Add 0.3 ml of solution G (1 m NaCl/PBS) to the testing area andwait 2 min.

(13) Recover the used solution G into a sterile tube as the sample, andadd 0.7 ml absolute ethanol. Ship the sample to the laboratory.

In The Laboratory:

(14) Store the sample at -20C over night because it helps precipitatethe DNA.

(15) Spin down the tube containing the sample at 14K G for 15 min at 4C.

(16) Re-suspend the sample in 10 ul Tris EDTA buffer (TE).

(17) Use the DNA to carry out a PCR amplification of the recA genefragment with the following primers:

P1: 5' TCC TCT CCA AGA GCA ACA CC 3'

P2: 5' CCA GCT TGT TCT TCA CCA CC 3'

(18) The presence of a PCR product indicates a positive result. Theabsence of a PCR product indicates a negative result.

EXAMPLE 3

A diagnostic kit for performing immunodetection in situ on skincomprises the following items:

(1) A solvent such as ethanol, acetone or saponin which increases theaccessibility of the immunoassay target molecules in skin cells.

(2) An adhesive ring which can be removably adhered to a skin surface.The ring forms a well within which various reagents solutions areapplied.

(3) A first step antibody solution.

(4) A second step antibody solution. This antibody binds to the firststep antibody, and is conjugated to either colloidal gold or to someother contrasting dyes and/or enzymatic markers.

(5) One or more of the following: (a) a chromogen reagent such as3-amino-9-ethyl carbazole (AEC); (b) a solution of streptavidin;©Biotinylated DNA.

(6) A non toxic washing buffer such a phosphate buffer saline or WALPOLE(Acetic Acid/Sodium acetate).

The immunodetection procedure consists generally of two shortincubations with the antibody solutions, and two washes with a non-toxicphosphate buffer saline (PBS) solution. Performing these applicationstakes approximately fifteen to thirty minutes and requires no specialskills.

The kit is utilized as follows:

(7) An area of the patient's skin cleaned with ethanol, and the adhesivering is removably adhered to the cleaned area. In its adhered positionthe ring defines the area of skin to be tested (the testing area).

(8) The first step antibody solution is brought into contact with thetesting area.

(9) After 5 minutes of incubation, the testing area and the entire workspace is washed briefly with a phosphate buffer solution at pH 7.1 toremove non-bound antibody.

(10) The second step antibody solution is brought into contact with thetesting area.

(11) The testing area is washed with a phosphate buffer solution at pH7.1.

(12) If an enzyme is used as a label, an appropriate chromogen reagentsuch as 3-amino-9-ethyl carbazole (AEC) is brought into contact with thetesting area.

6a) If biotin is used as a label, a solution of streptavidin is broughtinto contact with the testing area. The streptavidin is incubated for 5minutes, and then the testing area and the entire work space is washedwith a solution of phosphate buffer.

6b) Biotinylated DNA is brought into contact with the testing area.After 10 minutes the testing area and the entire work space is washedwith phosphate buffer at pH 7.1, and then incubated with WALPOLE (aceticAcid Sodium Acetate) buffer at pH 3.5 for 5 minutes.

6c) The WALPOLE buffer is neutralized with 10× phosphate buffer andrecovered.

6d) A portion of the WALPOLE/phosphate buffer is then used forpolymerase chain reaction using the appropriate primers. Primers toamplify the DNA fragment probe are known to those in the art. Thepolymerase chain reaction can be performed using a commerciallyavailable thermocycler, and the presence or absence of a product can betested by gel electrophoresis.

EXAMPLE 4

Candida albicans can be detected using the devices and methods disclosedabove in conjunction with one or more of the following reagentsavailable from the source indicated:

a. goat polyclonal Ab, Memorial Sloan-Kettering Cancer Inst.

b. rabbit polyclonal Ab, Biodesign International

c. goat polyclonal Ab,Immuno-mycologics Inc.

d. mouse mab, Virostat

e. mouse mab, Chemicon International

f. mouse mab, Biodesign International

EXAMPLE 5

Aspergillus can be detected using the devices and methods disclosedabove in conjunction with one or more of the following reagentsavailable from the source indicated:

Aspergillus c.

a. fixing goat polyclonal Ab, Immuno-mycologics, Inc.

b. gel diffusion goat polyclonal Ab, Immuno-mycologics, Inc.

Aspergillus mycelia

c. goat polyclonal Ab, Meridian Diagnostic Inc.

EXAMPLE 6

Clostridium perfringens, bacteria associated with gangrene, can bedetected using the devices and methods disclosed above in conjunctionwith one or more of the following reagents available from the sourceindicated:

Clostridium perfringens ABCD

a. ABCD rabbit polyclonal Ab, Accurate Chem. & Scientific Co.

Clostridium perfringens C

b. goat polyclonal serum, Techlab

Clostridium perfringens D

c. goat polyclonal serum, Techlab

Clostridium perfringens E

d. goat polyclonal serum, Techlab

EXAMPLE 7

Bacteria and toxoid associated with tetanus can be detected using thedevices and methods disclosed above in conjunction with one or more ofthe following reagents available from the source indicated:

Clostridium tetani

a. human Ig polyclonal Ab, Massachusetts Biological lab or MILES INC.

Clostridium tetani toxoid

b. human serum polyclonal Ab, North American Biological Inc.

EXAMPLE 8

Herpes viruses can be detected using the devices and methods disclosedabove in conjunction with one or more of the following reagentsavailable from the source indicated:

Herpes simplex type 1

a. Goat serum, Biochemed Corp. CA

b. goat polyclonal IgG, Biodesign International

c. Mouse mab, Biogenesis.

Herpes simplex type 2

d. rabbit polyclonal Ab, Cortex Became.

e. rabbit serum polyclonal IgG, Biogenesis LTD.

f. mouse mab, Cortex Became

g. mouse mab, Media Batik, Inc.

EXAMPLE 9

Papilloma virus can be detected using the devices and methods disclosedabove in conjunction with one or more of the following reagentsavailable from the source indicated:

Papilloma Virus in general

a. mouse mab, Passel & Lore GmbH & Co.

b. rabbit polyclonal Ab, Zymed laboratory

Papilloma Virus type 1,6,11,16,18,31

c. IgG mouse mab, Chemicon International Inc.

Papilloma Virus type 16,E1,E4

d. IgG1 17D5 mab purified, Pharmigen

EXAMPLE 10

Mycobacterium leprae, the bacteria associated with leprosy (Hansen'sdisease) can be detected using the devices and methods disclosed abovein conjunction with one or more of the following reagents available fromthe source indicated:

a. cell wall protein IgG1 mab, NIAID Leprosy Program

b. major membrane protein IgG1 mab, NIAID Leprosy Program

c. bacterioferitin IgG1 mab, NIAID Leprosy Program

d. cell wall protein poly-clonal Ab, NIAID Leprosy Program

e. cell wall protein poly-clonal Ab, NIAID Leprosy Program

f. phenolic glycolipid poly-clonal Ab, NIAID Leprosy Program

EXAMPLE 11

Treponema pallidum, the bacteria associated with syphilis, can bedetected using the devices and methods disclosed above in conjunctionwith one or more of the following reagents available from the sourceindicated:

a. human serum, polyclonal WHO-3, International Lab For Biol.

b. rabbit serum Ig, polyclonal, Becton Dickinson Microbiology

c. vdrl-reactive human serum, polyclonal, Biomedical Resources

d. RPR-reactive human serum 2173, Scimedx Corp.

EXAMPLE 12

Melanoma associated antigens can be detected using the devices andmethods disclosed above in conjunction with one or more of the followingreagents available from the source indicated:

a. 25/110 kd IgG1 nab NKI-C3, CALTAG LABORATORY INC.

b. IgG1 95/100 kd IgG1 nab, PAL-M2 ACC, Accurate Chemical & Sci. Co.

c. IgG1 PAL-M1 mab, Accurate Chemical & Sci. Co.

d. Other--The Linscott's directory contains more than 30 entries foranti-melanoma antibodies. ('94-'95 Ed., 4877 granges road Santa Rosa,Calif., 95404 USA, Tel:(707) 544-9555 Fax:(415) 389-6025)

EXAMPLE 13

HIV virus associated with AIDS can be detected using the devices andmethods disclosed above in conjunction with one or more of the followingreagents available from the source indicated:

a. HIV gp41 antibody MAb 2A2, ICN Pharm. cat: 158366, 1995

b. HIV gp120, antibody MAb 1c1, ICN Pharm. cat: 158367, 1995

c. HIV VAR2, Advanced Immunochemical Inc.

d. HIV P17, Cellular Product Inc.

e. HIV1 ENV HL1, Biodesign International

f. Other--The Linscott's directory contains more than 70 entries forboth monoclonal and polyclonal anti-HIV antibodies

EXAMPLE 14

Leukemias can be detected using the devices and methods disclosed abovein conjunction with one or more of the following reagents available fromthe source indicated:

Leukemia HTLV

a. HTLV P19 IgG2a mouse mab, Dupont-Nemours Research products

b. HTLV-I IgG1 mouse mab, 0.5 α NIH-11, Nat'l Institutes of Health,Rockville, Md.

c. HTLV-gp21 IgG1, Chemicon International Inc.

d. HTLV-I&II p24 IgG1 6f10 mouse mab, Sera-Lab Ltd.

e. HTLV-I GAG P19 111-130, frag sheep purified polyclonal, AALTO BioReagents Ltd., Publim 14, Ireland

f. HTLV-I p19/28 mouse mab, Chemicon International Inc.

g. Other--The Linscott's directory contains more than 25 entries forboth Leukemia HTLV antibodies

EXAMPLE 15

Many other systemic diseases can be detected using the devices andmethods disclosed above in conjunction with one or more availableantibodies. Such diseases include polyoma, measles and rubella, forwhich antibodies are listed in the Linscott's Directory.

REFERENCES

1) Cantor C. R. Nucleic Acid binding drug symposium Palo Alto Calif.Jan. 30 1994

2) Sano T., Smith CL., Cantor CR., Immuno-PCR: very sensitive antigendetection by means of specific antibody-DNA conjugates. Science 1992258: 120-122.

3) Gottesman, M. M., Willingham, M. C., Thiebaut, F., Pastan, I.Expression of the MDR1 gene in normal human tissues. Molecular andCellular Biology of Multidrug Resistance in Tumor Cells, (Roninson, I.,ed.) Plenum Publishing Corp., New York, N.Y., 1989.

3) Levy JA. Pathogenesis of human immunodeficiency virus infection.Microbial. Rev. 57:183-289 1993 20).

4) Gown AM., In: DeLellis RA (ed) Advances in Immunohisto-chemistry. NewYork: Raven Press 31-45 1988

5) Zanbruno G., Mori L., Marconi A., Mongiardo N., de Rienzo B.,Bertazzoni U., Giannetti A. Detection of HIV-1 in epidermal Langerhanscells of HIV--infected patient using the polymerase chain reaction. J.Invest. Dermatol. 96:979-982 1991

6) Tschachler E., Groh V., Popovic M., Mann D., Konrad K., Safai B.,Eron L., Dimarzo Veronese F., Wolff K., Stingl G. Epidermal Langerhanscells a target for HTLV-III/LAV infection. J. Invest. Dermatol.88:233-237 1987.

7) Rappersberger K., Gartner S., Schenk P., Stingl G., Groh V.,Tschachler E., Mann D., Wolff K., Konrad K., Popovic M. Langerhans Cellsare an actual site of HIV-1 replication. Intervirology 29:185-194 1988

8) Kanitakis J., Escaich S., Trepo C., Thivolet J. Detection of humanimmunodeficiency virus-DNA and RNA in the skin of HIV-1 infectedpatients using the polymerase chain reaction. J. Invest. Dermatol.97:91-96 1991

9) Gottesman, M. M., Golstein, L. J., Bruggemann, E., Currier, S. J.,Galski, H., Cardarelli, C., Thiebaut, F., Willingham, M. C., Pastan, I.1988 Molecular diagnosis of multidrug resistance. In Molecular Diagnosisof Cancer, Cold Spring Harbor Laboratory, Cold Spring Harbor, N.Y.,7:75-80, 1989.

10) Angov, E. and Camerini-Otero, R. D. The recA gene from thethermophile Thermus aquaticus YT1: cloning, expression, andcharacterization. J. Bacteriol. 176,1405-1412 (1994)

11) Current protocols in immunology National Institutes of Health GreeneWiley Editor Collican J. E. et Al. 1991.

What is claimed is:
 1. A method for detecting a target antigenproximally associated with a body component comprising:providing a firstantibody which binds to the target antigen; contacting a portion of thebody component in situ with the first antibody; allowing the firstantibody to bind with the antigen to form an antibody/antigen complex;labeling the antibody/antigen complex; and detecting the label whereinthe presence of the label indicates the presence of a target antigen. 2.The method of claim 1 wherein the body component comprises skin of aliving patient.
 3. The method of claim 2 further comprising removablyplacing a retainer in juxtaposed relation to the skin to define a workspace, and contacting the antigen with the first antibody within thework space.
 4. The method of claim 3 further comprising amplifying thelabel.
 5. The method of claim 4 wherein the step of amplifying the labeltakes place in situ.
 6. The method of claim 4 wherein the label isattached to the first antibody.
 7. The method of claim 4 wherein thelabel is coupled to the antibody/antigen complex during amplification.8. The method of claims 6 or 7 wherein a second antibody is brought intocontact with the antibody/antigen complex to render the complexmacroscopically detectable.
 9. A method for detecting a target antigenon the skin of a patient comprising:providing a labeled first antibodywhich selectively binds to the target antigen; placing a retainer injuxtaposed relation to the skin to define a work space; contacting theskin with the first antibody within the work space; allowing the firstantibody to bind with the antigen to form an antibody/antigen complex;amplifying the label; and detecting the label wherein the presence ofthe label indicates the presence of a target antigen.
 10. The method ofclaim 9 wherein the label comprises biotin, and the amplification stepcomprises addition of a biotinylated substance.
 11. The method of claim9 wherein the label comprises an oligonucleotide, and the amplificationstep comprises a polymerase chain reaction.
 12. The method of claims 10or 11 further comprising rendering the antibody/antigen complexmacroscopically detectable.
 13. An in situ immunodetection kit fordetecting a target antigen proximally associated with a section of skin,the kit comprising:a retainer which can be affixed to the skin to definea testing area; a labeled antibody solution which binds to the targetantigen at the testing area to form an antibody/antigen complex; andreagents for detecting the label.
 14. The kit of claim 13 furthercomprising at least one of: (a) a chromogen reagent; (b) streptavidin;and a biotinylated oligonucleotide.
 15. The kit of claim 14 wherein theantibody solution contains a mixture of monoclonal antibodies.
 16. Thekit of claim 14 wherein the antibody solution contains polyclonalantibodies.
 17. The kit of claim 14 wherein the retainer comprises abandage having a section containing the antibody solution.
 18. The kitof claim 14 wherein the retainer separates the testing area into atleast two sections.
 19. An in situ kit for detecting a disease conditionof a body comprising:an antibody which selectively binds to a targetantigen proximally associated with a component of the body; a retainerremovably affixed to the body and defining a work space in which theantibody is applied; a label which is coupled to the first antibody toprovide a signal; and chemical amplification of the signal.
 20. The kitof claim 19 wherein the antibody contains a mixture of monoclonalantibodies.
 21. The kit of claim 19 wherein the antibody containspolyclonal antibodies.
 22. The kit of claim 19 wherein the retainerseparates the testing area into at least two sections.
 23. The kit ofclaim 19 wherein the label comprises biotin, and the amplificationcomprises addition of a biotinylated second antigen.
 24. The kit ofclaim 19 wherein the label comprises an oligonucleotide, and theamplification comprises use of polymerase chain reaction.
 25. The kit ofclaim 19 wherein the amplification takes place in situ.
 26. The kit ofany of claims 20-25 further comprising rendering the signalmacroscopically detectable.
 27. The kit of claim 26 wherein the diseasecondition comprises infection with a fungal pathogen.
 28. The kit ofclaim 27 wherein the disease condition comprises infection with Candidaalbicans.
 29. The kit of claim 27 wherein the disease conditioncomprises infection with Aspergillus.
 30. The kit of claim 26 whereinthe disease condition comprises a neoplasm.
 31. The kit of claim 30wherein the disease condition comprises melanoma.
 32. The kit of claim30 wherein the disease condition comprises leukemia.
 33. The kit ofclaim 30 wherein the disease condition comprises polyoma.
 34. The kit ofclaim 26 wherein the disease condition comprises infection with abacterial pathogen.
 35. The kit of claim 34 wherein the diseasecondition comprises infection with Clostridium perfringens.
 36. The kitof claim 34 wherein the disease condition comprises infection withClostridium tetani.
 37. The kit of claim 34 wherein the diseasecondition comprises infection with Mycobacterium leprae.
 38. The kit ofclaim 34 wherein the disease condition comprises infection withTreponema pallidum.
 39. The kit of claim 26 wherein the diseasecondition comprises infection with a viral pathogen.
 40. The kit ofclaim 39 wherein the disease condition comprises measles.
 41. The kit ofclaim 39 wherein the disease condition comprises infection with rubella.42. The kit of claim 39 wherein the disease condition comprisesinfection with Herpes virus.
 43. The kit of claim 39 wherein the diseasecondition comprises infection with Papilloma virus.
 44. The kit of claim39 wherein the disease condition comprises infection with HIV.